Medical Director, Appeals

Centene Corporation

Medical Director driving medical management and quality improvement initiatives for Centene, impacting 28 million members across the United States.

Posted 5/19/2026full-timeRemote • Montana • 🇺🇸 United StatesLead💰 $236,500 - $449,300 per yearWebsite

About the role

Key responsibilities & impact

Assist the Chief Medical Director to direct and coordinate medical management, quality improvement and credentialing functions
Provides medical leadership for utilization management, cost containment, and medical quality improvement activities
Performs medical review activities pertaining to utilization review, quality assurance, and complex medical services
Supports effective implementation of performance improvement initiatives for capitated providers
Assists in planning and establishing goals and policies to improve quality and cost-effectiveness of care
Provides medical expertise in operation of approved quality improvement and utilization management programs
Assists in the functioning of physician committees
Conducts regular rounds to assess and coordinate care for high-risk patients
Collaborates with clinical teams, network providers, and medical consultants for reviewing complex cases
Participates in provider network development and market expansion
Develops and implements physician education with respect to clinical issues

Requirements

What you’ll need

Medical Doctor or Doctor of Osteopathy
Utilization Management experience and knowledge of quality accreditation standards preferred
Actively practices medicine
Course work in Health Administration, Health Financing, Insurance, and/or Personnel Management advantageous
Experience treating or managing care for a culturally diverse population preferred
Active Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association’s Department of Certifying Board Services
Certification in Internal or Family Medicine specialty preferred
Current state license as MD or DO without restrictions, limitations, or sanctions from government programs

Benefits

Comp & perks

competitive pay
health insurance
401K and stock purchase plans
tuition reimbursement
paid time off plus holidays
flexible approach to work with remote, hybrid, field or office work schedules

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

utilization managementquality improvementmedical reviewcredentialingcost containmentperformance improvementclinical educationpatient care coordinationquality assurancemedical expertise

Soft Skills

leadershipcollaborationcommunicationplanninggoal settingorganizational skillsinterpersonal skillscultural competency

Certifications

Medical Doctor (MD)Doctor of Osteopathy (DO)Board certification in medical specialtyCertification in Internal MedicineCertification in Family Medicine